Training offensive brings ultrasound imaging to Lesotho mountains

Dr. Daniel Mantuani trains nurses at Mamohau Hospital.

Ultrasound imaging has long served as an invaluable diagnostic tool for clinicians in the United States and other wealthy countries, not to mention a routine way for expectant parents to get a first glimpse of their babies. Now, following a two-week training offensive in late January, ultrasound is being used for the first time to save lives and assist nurses and doctors at health centers high in the mountains of Lesotho.

“Today we found a set of twins in one woman who didn't know she was pregnant, and another with a placenta previa (potentially life threatening if it bleeds later in pregnancy)," Dr. Sachita Shah reported in an email from one of the remote mountain clinics. Shah is a specialist in emergency medicine and ultrasound at the University of Washington and the lead author of the PIH Manual of Ultrasound for Resource-Limited Settings. She conducted the training in Lesotho along with her colleague Dr. Daniel Mantuani, a fellow in emergency ultrasound at Alameda County Hospital in Oakland, CA.

During their two weeks in Lesotho, Shah and Mantuani hopscotched by single-engine plane from one isolated mountain clinic to another, training nurses at six of the seven rural health centers operated by PIH. At each clinic, they made sure that the portable ultrasound machine provided at a steeply discounted price by Sonosite was working properly and that there was at least one person trained to use it. In several cases, as Shah reported, the nurses put their training to use immediately to provide lifesaving care.

PIH-Lesotho nurses Mabathoana Phaila (rear) and Mohloki Chere (foreground) put their ultrasound training to use.

“Just wanted to let you know that we had a great ultrasound save case today at Bobete health center in the mountains," Shah wrote in another email. "A 32-year-old woman presented to our clinic, supposed to be in her first trimester sometime, with bleeding and lower abdominal pain. She was pale and dizzy with standing, with a heart rate well above normal. Our nurses grabbed the Sonosite Titan ultrasound machine and me, and started scanning her. They realized her uterus was empty and she was bleeding from a ruptured ectopic pregnancy, which can be life-threatening.

"We were able to transport her in the single car to the nearest operating room an hour away but she remained stable. Right after she left, we realized we forgot her chart, and so the nurse ran off into the hills to chase down a horse-riding local, who rode off, chart in hand, to cut the ambulance-car off at the next crossing to give them the chart…It was a rapid diagnosis of a life-threatening disease by our newly ultrasound-trained maternity nurses here! So exciting….."

Shah and Mantuani also trained clinicians at the two hospitals where PIH works in Lesotho. At Mamohau Hospital in the mountains, they trained a total of 14 nurses, focusing on use of ultrasound to assist in pregnancy, labor, and delivery. The course brought together nurses who work in the hospital's maternity ward and others who administer PIH's Maternal Mortality Reduction Program and five health centers. And at Botsabelo Hospital, the national referral center for treatment of drug-resistant tuberculosis, they taught doctors how to use ultrasound to detect fluid that can accumulate around the heart and in the lungs of TB patients.